Oral delivery system

ABSTRACT

The present invention provides a delivery system for the treatment and/or prevention of infectious pathological changes, including compositions comprising polyhexanide, various pharmaceutical formulations, and processes for using these formulations in oral treatment modalities.

CROSS REFERENCE TO RELATED APPLICATIONS

This application is a Continuation of U.S. application Ser. No.15/786,938, filed Oct. 18, 2017, which is a Continuation of U.S.application Ser. No. 14/335,873, filed Jul. 18, 2014, now U.S. Pat. No.9,820,918, issued Nov. 21, 2017, which claims priority from GermanPatent Application Serial No. 20 2014 101 882.4, filed Apr. 22, 2014,each of which is incorporated by reference herein in its entirety.

BACKGROUND OF THE INVENTION Field of the Invention

The present invention relates to an oral delivery system for thetreatment and/or prevention of periodontal, peri-implant and otherbacterial and viral diseases or fungal diseases in the area of the mouthand throat as well as halitosis: i.e., infectious pathological changes.

Background Information

Infectious pathological changes occur very often and are the main reasonfor tooth loss/implant loss and halitosis in humans over 35 years ofage. An infectious pathological change can be understood to mean aninfection or inflammation of the gingival pocket, which, in severalsteps, can cause loss of bone holding the tooth/implant. There aredifferent degrees of severity of the condition. Lighter cases relate tothe clinically termed gingivitis, whereas more severe cases areclinically called periodontitis/peri-implantitis.

Gingivitis is an inflammation of the gingiva (or of the gums), which isoften caused by poor oral hygiene and/or the hormonal state of thepatient. It is assumed that the untreated gingivitis develops into aperiodontitis/peri-implantitis. Periodontitis is a bacterial diseasewhich attacks the gingival tissue, the teeth, implants and the bonesurrounding the teeth/implants.

The oral cavity is a substantially aerobe environment through whichsaliva is flowing. In contrast, the periodontal/peri-implantmicroenvironment is rather anaerobic and plasma filtrate is flowingthrough it, which is called “gingival crevicular fluid”. The growth ofmicroorganisms within this microenvironment is believed to beresponsible for the occurrence of an infectious pathological change.Hence, treatment of said change is directed at monitoring andinfluencing said growth.

Trials in treating infectious pathological changes by agents which areadministered into the oral cavity, such as antibacterial agents, havegenerally proved ineffective because the periodontal/per-implant pocketis substantially inaccessible. On the other hand, the systemicadministration of antibiotics has only little success in treatingperiodontal diseases.

Antibacterial agents, such as chlorhexidine and quaternary ammoniumsalts, in the form of mouth rinses have proved somewhat effective in theprophylaxis/treatment of infectious pathological changes. These agents,however, have different disadvantages. For instance, they are oftenaccompanied by side effects, such as discoloration of the teeth, tongue,mucous membranes or of dental prostheses. Furthermore, these agents ofthave a bad taste and affect the patient's sense of taste. Moreover,these agents often disturb wound healing. In addition, the agents areregularly absorbed by the mucous membranes or by the gastro-intestinaltract, which may lead to systemic effects. Further, toxic metabolitesare often produced from the abovementioned agents. Another disadvantagelies in that the abovementioned agents usually have to be used at veryhigh concentrations in order to achieve a corresponding effect. Further,allergenic potential was observed. Additionally, the abovementionedagents often have irritant effects and do not have particularly longshelf lives. Moreover, it was observed that blood and proteins influencethe effects of these agents.

Pharmaceutical compositions which exhibit a release of agents and whichcan be introduced into the periodontal cavity and slowly release anantimicrobial agent have been developed. For example, U.S. Pat. Nos.4,764,377 and 4,892,736 disclose the introduction of tetracycline intonon-degradable polymeric fibers which can be wound around the teeth andrelease the antibiotic in the periodontal cavity over several days.However, the fibers must be fixed in their place with an adhesive and beremoved again at the end of the treatment method.

U.S. Pat. No. 4,569,837 discloses the use of water-soluble polymericsubstances (e.g. methyl cellulose, gelatin, etc.) as a polymeric matrixfor a periodontal implant.

U.S. Pat. No. 5,002,769 discloses a biodegradable system for oraladministration with delayed release for treating periodontal diseases.The agent is embedded into a matrix of hydrolyzed gelatin which iscross-linked with glutaraldehyde.

The above-described compositions show varying effectiveness in reducingthe bacterial load in the periodontal pocket and in reducing the depthof the pocket. Moreover, these compositions often have theabove-mentioned disadvantages.

SUMMARY OF THE INVENTION

It is the object of the present invention to provide an effectivedelivery system for the treatment and/or prevention of infectiouspathological changes which is easy to use and effective at the sametime.

The object is attained by an oral delivery system of the kind mentionedabove, which comprises polyhexanide.

Polyhexanide has been found to be particularly effective in the use oforal delivery systems for treating and/or preventing periodontaldiseases. Polyhexanide can in particular be used in the kind of deliverysystems by means of which a slow release in the area of the gingivalpockets is to be achieved so that a prolonged contact time isaccomplished.

In a preferred version of the oral delivery system, the latter is in asolid pharmaceutical form. A solid pharmaceutical form is particularlyadvantageous in the use of the system.

In a preferred embodiment of the oral delivery system, the latter is inthe form of a chewing gum. Among other advantages, chewing gumscounteract the delayed effect observed in polyhexanide because they canbe easily used by the patient over a longer period of time, which wouldbe a problem with mouth rinses, for example.

DETAILED DESCRIPTION OF THE INVENTION

Before the present composition, methods, and methodologies aredescribed, it is to be understood that this invention is not limited toparticular compositions, methods, and experimental conditions described,as such compositions, methods, and conditions may vary. It is also to beunderstood that the terminology used herein is for purposes ofdescribing, particular embodiments only, and is not intended to belimiting, since the scope of the present invention will be limited onlyin the appended claims.

As used in this specification and the appended claims, the singularforms “a”, “an”, and “the” include plural references unless the contextclearly dictates otherwise. Thus, for example, references to “anaromatic substance” includes one or more aromatic substances, and/orcompositions of the type described herein which will become apparent tothose persons skilled in the art upon reading this disclosure and soforth.

Unless defined otherwise, all technical and scientific terms used hereinhave the same meaning as commonly understood by one of ordinary skill inthe art to which this invention belongs. Any methods and materialssimilar or equivalent to those described herein can be used in thepractice or testing of the invention, as it will be understood thatmodifications and variations are encompassed within the spirit and scopeof the instant disclosure.

As used herein, “about,” “approximately,” “substantially” and“significantly” will be understood by a person of ordinary skill in theart and will vary in some extent depending on the context in which theyare used. If there are uses of the term which are not clear to personsof ordinary skill in the an given the context in which it is used,“about” and “approximately” will mean plus or minus <10% of particularterm and “substantially” and “significantly” will mean plus orminus >10% of the particular term.

As stated above, in one embodiment of the oral delivery system, thesystem is in the form of a chewing gum. Chewing gum is generallycomposed of the following groups of raw materials: gum base or gum mass,plasticizers, filler materials, lubricants, fats, emulsifiers, aromas,dyes, antioxidants, and edible acids for flavoring. As gum mass, eithernatural materials such as chicle, gutta-percha, latex, benzoin resins orgum arabic or consistency-providing, synthetic thermoplastics, such aspolyvinyl acetate in amounts of up to about 65% of the gum mass,polybutadiene styrene, polyisobutylene, isoprene, polyvinyl ether, andpolyethylene can be used.

Typical plasticizers are emulsifiers, resins, waxes or glucitol. Typicalfiller materials are magnesium stearates, chalk, calcium carbonate,silicate or celluloses. The filler materials and technical auxiliarysubstances maintain flowability and prevent clumping of the particles atlow pressure. Mineral oils, microcrystalline waxes or herbal oils aretypically used as lubricants, fats or emulsifiers. These auxiliarysubstances prevent clumping of the formulations and undesired adhesionto instruments in the oral cavity.

Traditional chewing gums can be highly cariogenic because of their highsugar content, but they also massage the gingiva and the salivary glandsin case of dry mouth. Chewing gums are also refreshing, vitalizingand/or thirst-quenching owing to the added flavorings.

To avoid the above-mentioned cariogenic effect of sugar in chewing gums,sugar-free chewing gums have been on the market for a long time. Insteadof sugar, they contain sugar substitutes, which are mainly sorbitol andxylitol.

The chewing gum according to the invention is intended to support teethand mouth hygiene and for the treatment/prevention of infectiouspathological changes. It is particularly suited for “on-the-go”, whenthere is no opportunity to brush the teeth. The chewing gum according tothe invention is usually sugar-free and, similarly to tooth paste,contains traces of minerals for the regeneration of the teeth. Thechewing gum according to the invention may also comprise at least oneabrasive, in particular calcium carbonate, calcium phosphates,metaphosphates, silicic acid, aluminum oxides, silicates, talcum and/orcombinations thereof.

Further, the chewing gum according to the invention may comprise atleast one suspending agent or a humectant, in particular water,glycerin, propylene glycol and/or sorbitol syrup, and at least onethickening agent, stabilizer, binder and/or combinations thereof, inparticular gels, starches, alginates, oils and/or cellulose gum.

For improving the taste properties, at least one aromatic substance, atleast one sweetener and/or at least one sugar substitute, in particularmenthol, peppermint oil, sodium saccharin, aspartame, acesulfame,sorbitol, maltitol, xylitol, fructose, and/or combinations thereof, maybe added to the chewing gum.

Moreover, the chewing gum according, to the invention may comprisefurther chemical additives, dyes and/or pH regulators, in particularfluorides, astringents, inflammation inhibitors, desensitizers,vitamins, panthenol, white pigments, sodium hydroxide, and/orcombinations thereof.

By way of the oral delivery system according to the invention in theform of a chewing gum, the polyhexanide may reach the site of action, inparticular the gingival pockets, in a particularly effective manner. Thechewing process presses the chewing gum into the gingival pocket, wherethe polyhexanide is then released.

In another embodiment of the delivery system according to the invention,the latter is in the form of a chip or film, comprising a biodegradableor bioerodible pharmaceutically acceptable polymer.

The chip or film according to the invention is suitable for beingimplanted into a periodontal pocket and is capable of treatinginfectious pathological changes in which a delayed release ofpolyhexanide is desired. The pocket may be a natural pocket, it may berelated to a state of disease or it may be intentionally opened as partof the treatment. After implantation, the chip or film softens, swellsup and changes into a soft paste, which adheres to the inside of thepocket.

Preferably, the chip or film may comprise at least one cross-linkinganent, which is present in an amount sufficient to make the polymerwater-insoluble while permitting the release of the polyhexanide fromthe delivery system.

The film or chip according to the invention preferably comprises asurfactant, which is preferably selected from anionic, cationic,non-ionic surfactants and/or combinations thereof. The non-ionicsurfactants can be selected from polyoxyethylene sorbitan fatty acidesters (polysorbate) and sorbitan fatty acid esters.

The chip or film according to the invention is preferably adapted to beadministered into a periodontal pocket with in-vivo releasing propertieswhich are aimed at reducing the depth of a periodontal pocket of apatient.

Advantageously, the chip or film according to the invention is in such aform that it is biodegraded within the periodontal pocket, wherein itbecomes soft and adheres to the periodontal pocket and wherein, onceinserted in a periodontal pocket, it gradually releases the polyhexanideover a period of at least about 24 hours, during which the chip or filmconverts into a soft material. The chip thus serves as a medium ofdelivery of polyhexanide as antimicrobial agent for application into thesulcus or gingival pocket. The size of a chip/film according to theinvention is generally about 3×3 to about 10×10 mm. In general, the baseof the chip/film is a gelatin cross-linked with glutaraldehyde.Cross-linked gelatin has proved particularly suitable for the delayedrelease of polyhexanide.

Advantageously, the polymer is selected from water-soluble protein,cellulose or a cellulose derivative, starch or a starch derivative,glyceryl monostearate, carbomer, PVP (polyvinyl pyrrolidone), gum,acacia gum, guar gum, polyvinyl alcohol, polyhydroxyethyl methacrylate,polyhydroxymethyl methacrylate acrylic acid, polyacrylamide,polyethyleneglycolene, polyacetic acid, polyglycolic acid, copolymers ofpolyacetic acid and polyglycolic acid, polyanhydrides andpolyorthoesters. The water-soluble protein is preferably selected fromthe group consisting of gelatin, collagen, albumin, an enzyme andfibrinogen.

In another embodiment of the system according to the invention, thelatter is in the form of a gel or salve. In this form, it is usuallyintroduced into the gingival pockets, where it releases polyhexanide tothe surroundings.

The gel or salve according to the invention is for intraoralapplication, in particular for application into the sulcus or into agingival pocket. The polyhexanide here again serves as an antimicrobialagent. The gel/salve according to the invention may be based on aconventional ethanoliglycerol/macrogol compound.

The gel according to the invention or the salve according to theinvention may be both a ready-to-use preparation and a mixing system. Incase of a mixing system, certain components are mixed only shortly priorto the application and brought to the diseased site. This has theadvantage, among others, that a mixing system is easy to process aftermixing. For instance, in one embodiment, a viscous mass may at first bepresent after mixing which hardens only after it has been introducedinto the mouth. This significantly simplifies the application. Themixing system may be in the form of a mixing capsule, for example.

As compared to the known antibacterial agents, such as chlorhexidine,the oral delivery system according to the invention has decisiveadvantages. For instance, the polyhexanide used in the oral deliverysystem according to the invention is not cytotoxic. Additionally, noside effects, such as discoloration of the teeth, tongue, mucousmembranes or of dental prostheses can be observed. The used polyhexanideis tasteless and does not compromise the sense of taste. Further, itdoes not disturb wound healing and reduces fibrin formation.Furthermore, it is not known to be absorbed by the mucous membranes orvia the gastrointestinal tract. Further, no toxic metabolites fibrinduring use. Another significant advantage lies in the fact that theeffective concentration of polyhexanide is many times lower than that ofchlorhexidine. Further, polyhexanide has no allergenic potential and noirritant effect. As far as is known, polyhexanide is not sensitizing.The shelf life of polyhexanide is also longer than in conventionalagents. Moreover, no development of resistance has been observed.Polyhexanide has a broad effective spectrum and shows very littleprotein and blood interference (effect is hardly influenced by proteinsor blood).

Although the invention has been described with reference to the abovedisclosures, it will be understood that modifications and variations areencompassed within the spirit and scope of the invention. Accordingly,the invention is limited only by the following claims.

All references recited in this disclosure are incorporated by referenceherein in their entireties.

We claim:
 1. A chewing gum comprising polyhexanide in an amounteffective to treat infectious pathological changes in the mouth andthroat.
 2. The gum of claim 1, wherein the gum further comprises atleast one suspending agent or humectant selected from the groupconsisting of water, glycerin, propylene glycol, sorbitol syrup, andcombinations thereof.
 3. The gum of claim 1, wherein the gum furthercomprises at least one thickening agent, stabilizer, or binder.
 4. Thegum of claim 3, wherein the at least one thickening agent, stabilizer,or binder is selected from the group consisting of a gel, a starch, analginate, an oil, a cellulose gum, and combinations thereof.
 5. The gumof claim 1, wherein the gum further comprises a gum base selected fromthe group consisting of chicle, gutta-percha, latex, benzoin resin, andgum arabic.
 6. The gum of claim 1, wherein the gum comprises a syntheticthermoplastic gum base.
 7. The gum of claim 6, wherein the syntheticthermoplastic is selected from the group consisting of polyvinylacetate, polybutadiene styrene, polyisobutylene, isoprene, polyvinylether, and polyethylene.
 8. The gum of claim 1, wherein the gumcomprises a filler selected from the group consisting of magnesiumstearate, chalk, calcium carbonate, a silicate, and a cellulose.
 9. Thegum of claim 1, wherein the gum comprises at least one aromaticsubstance, sweetener, or sugar substitute.
 10. The gum of claim 9,wherein the at least one aromatic substance, sweetener, or sugarsubstitute is selected from the group consisting of menthol, peppermintoil, sodium saccharin, aspartame, acesulfame, sorbitol, maltitol,xylitol, fructose, and combinations thereof.
 11. The gum of claim 1,wherein the gum comprises an emulsifier, a resin, a wax, or glucitol.12. The gum of claim 1, wherein the gum comprises an abrasive selectedfrom the group consisting of calcium carbonate, calcium phosphate, ametaphosphate, silicic acid, an aluminum oxide, a silicate, talcum, andcombinations thereof.
 13. The gum of claim 1, wherein the gum comprisesfluoride.
 14. The gum of claim 1, wherein polyhexanide is the only agentpresent in an antibacterially effective amount.
 15. The gum of claim 1,wherein the gum comprises fluoride and at least one aromatic substance,sweetener, or sugar substitute.
 16. The gum of claim 5, wherein fluorideand the at least one aromatic substance, sweetener, or sugar substituteare not present in antibacterially effective amounts.
 17. A method oftreating infectious pathological changes in the mouth and throatcomprising administering the gum of claim 1 to a patient in needthereof.
 18. The method of claim 7, wherein the infectious pathologicalchange is a periodontal disease.
 19. The method of claim 7, wherein theinfectious pathological change is gingivitis, periodontitis, orperi-implantitis.
 20. A method of delivering, polyhexanide into agingival pocket, the method comprising administering to a patient inneed thereof the gum of claim 1.